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PERMITTEE NAME/ADORESB IIR[IYdr NATIONAL POLLUTANT DI.OHARO• •LIMINATION •T•T[M (NPUtS) <br />p.duly name/LOr•tlon !r mmerentl DISCHARGE MONITORING REPORT r UMR) <br />L'A'"E_~,1Lr1YZD~:IIAL~-11SP~!iJL~L'~----- (1-161 (I7-IV) MTROR <br />ADDREeBL <br />!L.LlLE- - - _ _. - - - - - - - - C O C q :'i D D 7 0 0 A (SORB N N 1 Forgpl~PProved. <br />ALR~ <br />LD <br />C <br />C <br />. <br />PERMIT NUMBER oucrwYOY wur.rR o _ FTNAI. oMe NO. 2o4o-ooat <br />i~~r~~ <br />aL L <br />_17~LL~ <br />L <br />' <br />, <br />-------- <br />- <br />- <br />'~%• T'Ai LOR P'1'V4r9Y8~T~1,4:~~4CRecF <br />~~~~ <br />= <br />~'~ <br />'4 <br />1=~- <br />--' <br />----- <br />=-- <br />- <br />' <br />- MONITORING PERIOD <br />kAG~-------------------- YEAR MO DAY YEAR MO DAY <br />' <br />LOCATON <br />FROM TO tray ND nrs^11nRr.s ~ <br />~~ ~xaa <br />______ <br />_- <br />, <br />L T N t R. D. O S I L T D N V R E S I !) F M L (lo-Jl) (u-v) rJ+-JS) (J6-n) !IB-J9) (JaJ1) I NDTE: Read IRetructbns before complstinp lhls form. <br />' (3 Grd Only) QUANTITY OR LOADING (I GW Only) ~ QUALITY OR CONCENTRATION <br />PARAMETER (16-SI) (SI~i) (J8-IS (16-SJ) (SI~11 EX• FTE~ r BTYPE <br /> AVERAGE MAXIMUM' UNITE MINIMUM AVERAGE MAXIMUM 'UHITB (fNl) 61~f l/9'/~/ <br />0[L AND CYREIISE BAMPLE =aaaa~- ~ 71a) aoaxa'T aaaaa~ aaao-a•~ I <br />V I S U A L MEABUREMENT , <br />BiD66 1 D D aaaxar D' .=1 <br />P <br />' a aaaa aaaaaa' 4aaaao aaa ~ Iap~ <br />ERPLOEHT GRJSS VALUE PERMIT <br />I+En11neEMENr I!15* KAY . <br />. <br />'17=0 ~ aaaa ,,'"'e <br /> SAMPLE - <br /> MEABUREMENT <br /> POtM1T <br />~ : <br />~ 'l. ' ~.s <br />xn <br />~ <br />' REQUIREMWT.. ~ ~ .. I -v <br />r A:: <br />r <br />- r <br />. ^I <br />BAMPLE <br />T' <br />~ .. <br />_ MEABUREMENT <br /> PERMIT <br />., ~ _ `..j ,',v <br />~~ ~, 1 ..r, <br />'r'~ -.TI . '°* ~ 4 <br />~.'i'~ j~ <br /> REQUIREMENT I: - ' <br />I SAMPLE <br />a <br />I MEABUREMENT ~' <br />' ~ PERMIT ~ <br />~ ~ ~ nu 1.. ~'F; <br /> REQUIREMENT .. ? 4[ 1. ' <br />~ ~ BAMPLE ~ ~ <br /> MEASUREMENT <br /> PERMIT r r ~ r ' ~ `s .~ <br /> <br />' <br />~ SAMPLE ~ ~ ~ .. <br /> <br />. ~ <br />~ <br />, <br />„ <br />I MEABUREMENT <br />I PERMIT ~~' ~ ~ ~ <br />ty ... . i_, :.' - <br />I <br />'~' <br />' , i . <br />. <br />~,.. ;'w I <br />_ <br />~. REQUIREMENT ~ .. ~ 4: <br />' S .. ~a: .. .. <br />. ~ <br />-- <br />- BAMPLE <br />_ <br />' ~ <br />€'. MEABUREMENT <br /> <br />. <br />3 <br />- . ~.~ <br />r ,. <br />' <br />i REQUIREMENT 1 <br />. q)'' . <br />~' <br />4 <br />AMF/TITLE PRINCIPAL iXEGUTIVE OFFICER I cERnFr UNDER PENALTY OF uw rw.r I HAVE PER•MlAUr E%AMINED ~ ~ TELEPHONE D A T E <br />_ <br />- AND AM F4MILIAR WT1 TFE INFORMATpf1 SUBAITTED HEREIIy wND BASED <br />~ . <br />( <br />R <br />G <br />ATKINSON ~ ON Mr INOURY OF THOSE NDVDUALS IMMEDIATELY RESPONU°, c FOR <br />TmT <br />I <br />O <br />R <br />AT O <br />EVE <br />~ <br />rv 3038244461 4 1' ~ Q ~~ <br />. <br />. THA <br />AM AWARE <br />HERE AR <br />E <br />°a E <br />ACCURATE <br />A <br />ND <br />MPLETE - <br />I <br /> <br />VP LANDlENVIRONMENTALAFFAIR~ SICllIFIUNT PENALTIES FOR SUBMnTING FwLSE WFORMATgN INCLUDMG <br />THE Possleafrr OF FwE AND MPRISaNMENT. SEE le USC 1 IWI AND <br />I <br />BIGNATURHOFPRINOIPALExECUnVE I <br /> <br />TYPED OR PRINTED Yd[ rYKJ YY ro <br />33 USC. 1 1319 (1kN11rcl undR rMA frlNlH mq In[ <br />l16DB0 Ind Yr nMiimum impimnmenl a! Erween 6 months uld f ys.n) <br />OPPICER OR AUTHORIZED AGENT <br />NUMBIER <br />TEAR <br />MO <br />DI <br />'COMMENT AND EXPLANATION OF ANT VIOLATIONS (N[I[Rfl[r •ll •tf•cnmenN •rreJ .' -~. <br />;.SP.PRLEABLE SOLIDS LIM IT. IPPLIEi OH1.i T° Cc Iu=YR• ?LL-HR PR RCTIT ?YP.HP I> ALA T!I P,D. IF CL1TM APPRAYPD 9! <br />~.~Y1CD. !95 6-IRON LInTiS NfLL'RDI B.'. pPDfTPD T'1 H?PORTP•D HP.ASORF.n?NTS--SEE i.q.1A, P. ~ AHD I.@.LD• Pr. ~. <br />~Jr 3320•V .~. ti•HB) RWIOIB BCII%Oll~ R18y DB ISBC. (REPLACER EPA FARM ~~WNICJLMAY NOT !E UBEDJ 0 D Z 1 R / 9 4 0 0 2 2-16 5 7 ~~i ~~ 2 QF <br />4A'J (\~J I '~.J' <br />